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(A surgery nurse is seen beside the heart beat monitor in the operating theatre of the Unfallkrankenhaus Berlin (UKB) hospital in Berlin February 29, 2008. REUTERS/Fabrizio Bensch)

Many U.S. surgeons fail to discuss their patients’ wishes in case a risky operation goes awry, and even more would not operate if patients limited what could be done to keep them alive, a survey found.

Such medical wishes and plans for end-of-life care, called “advance directives,” outline what can and cannot be done if patients are unable to decide for themselves. The most famous examples are so-called living wills. But the restrictions are debated among doctors, said the survey, published in the Annals of Surgery.

“(Surgeons) feel the advance directive basically ties their hands behind their back, and they’re not given the tools to get them through the surgery,” said Margaret Schwarze, an assistant professor at the University of Wisconsin School of Medicine and Public Health, who was one of the survey’s authors.

She and her colleagues asked 912 surgeons who regularly perform risky operations 14 questions on how they discuss a patient’s advance directives and whether the directives influence their decision to operate.

More than four out of every five surgeons discussed which forms of life support the patients would like to limit. But only about half asked specifically about the patient’s advance directive, which can include restricting the use of feeding tubes and ventilators to keep a person alive.